Provider Demographics
NPI:1114338092
Name:ALL THE WAY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ALL THE WAY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-797-2587
Mailing Address - Street 1:8575 FERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5677
Mailing Address - Country:US
Mailing Address - Phone:318-797-2587
Mailing Address - Fax:318-797-2588
Practice Address - Street 1:8575 FERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5677
Practice Address - Country:US
Practice Address - Phone:318-797-2587
Practice Address - Fax:318-797-2588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1425111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty